Dermato-Venereology in the Nordic Countries
Controversies and Challenges in Venereology in Denmark
Kristian Kofoed 1 and Helle Kiellberg Larsen 2
1
Department of Dermatology, Venereal Clinic, Herlev and Gentofte Hospital, University of Copenhagen, and 2 Department of Dermato-venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
In recent years several challenges and controversies have arisen in the field of venereology in Denmark. Some of these challenges appear to be unique for Denmark, while others have also arisen in the other Nordic countries. Of course, it is possible that the issues faced in Denmark today may arise in other Nordic countries in the future.
Human papilloma virus
In February 2016, the human papilloma virus( HPV) vaccine was changed in the Danish childhood immunization programme; Gardasil was replaced by the vaccine Cervarix. Cervarix protects against the two oncogenic HPV types 16 and 18 that are responsible for approximately 70 % of all cervical cancers( 1). The two vaccines are similar with regards to the level of protection against cervical cancer and reported side-effects. However, unlike Gardasil, Cervarix does not protect against genital warts. When Gardasil was originally introduced into the Danish childhood immunization programme there was a significant decline in genital warts among both young women and men( 2). Following the change of vaccine to Cervarix, it is likely that the incidence of genital warts will increase once again. It is planned that all girls who have already received at least 1 dose of Gardasil are to be completed with this vaccine before the end of January 2017.
However, no matter which vaccine is included in the programme it will have no effect if the girls are not vaccinated. In Denmark the HPV vaccine is given at the age of 12 years. Statistics from Statens Serum Institute from April 2016 show that only 27 % of girls born in 2003 received the HPV vaccine. Thus, due to the low level of vaccine uptake, an alarming number of deaths from cervical cancer will not be prevented.
Until April 2016, a total of 242 women filed claims for HPV vaccine side effects to the Danish Patient Compensation Association, which decides compensation claims for patients injured in connection with treatment by the Danish Health Service. For comparison, only 37 persons in Sweden and 8 in Norway have filed a claim until April 2016( Danish Broadcasting Corporation, 23 April 2016).
In November 2015, the European Medicines Agency( EMA) released a new evaluation report on the safety of HPV vaccines. This reevaluation was done on a Danish initiative. The report concluded that the available evidence does not show that HPV vaccines are linked to the suspected serious side-effects postural orthostatic tachycardia syndrome( POTS) and complex regional pain syndrome( CRPS). In particular, the syndrome complex POTS was debated in Denmark in 2015. The conclusion drawn by the EMA was based on a thorough review of the published research articles, data from the companies’ clinical trials, and suspected adverse reactions reported by patients and doctors, as well as additional data provided by member countries, including Denmark. The EMA also consulted with a group of leading experts in the field of vaccines, POTS and CRPS, and assessed the detailed information received from a variety of patient groups. In December 2015, the World Health Organization( WHO)’ s Global Advisory Committee on Vaccine Safety( GACVS) pronounced on the safety of HPV vaccines. Like the EMA, GACVS concluded that, based on existing knowledge, there is no evidence of safety problems with the vaccines that would support changing the vaccines. Vaccine safety is monitored closely by both the EMA and the Danish Medicines Agency. Scandinavian doctors should therefore not be afraid to support national HPV immunization programmes.
Syphilis
Syphilis has been known in Europe for over 500 years. In 1530 the Italian physician Girolamo Fracastoro portrayed the disease symptoms in a poem about the shepherd Syphilus, who later became the eponym of the disease. The exact origin of syphilis is unknown; one hypothesis is that the disease was carried to Europe by returning crewmen on the Santa Maria from Christopher Columbus’ s voyage to the Americas. Syphilis, which also became known as the French disease, the Gallic disease and the Great Pox, spread rapidly as a deadly epidemic across Europe( 3).
This, in brief, is the historical description of syphilis. In the 1990s syphilis appeared to be predominantly a disease of historical interest, since it was considered almost extinct in
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